Beyond Quitting: The Great American Smokeout Amplifies Successes in Public Health Tobacco Control

November 15, 2018|1:06 p.m.| Marcus Plescia, MD, MPH | ASTHO Chief Medical Officer

Today is the Great American Smokeout, an event that the American Cancer Society has hosted for over 40 years every third Thursday of November. It began in the 1970s when smoking and secondhand smoke were more common and has since helped dramatically change Americans’ attitudes about tobacco. In the wake of new data that shows cigarette smoking among adults is at an all-time low, this year’s observance is an opportunity to both reflect on a major public health success story and look ahead at new policy and systems change strategies to reduce the harmful health effects of all tobacco products on the market. E-cigarettes, for example, continue to pose a significant threat: e-cigarette use among U.S. high school students increased by 78 percent between 2017 and 2018.

Historically, public health tobacco control efforts have focused on evidence-based approaches aimed at youth. Nearly 9 in 10 smokers begin before age 18. Taxing tobacco products, launching hard-hitting media campaigns, and banning smoking in public places have been highly effective interventions to reduce the appeal of smoking among youth. Recently, many tobacco control groups—including the CDC—have shifted more attention to help adult smokers quit. States have an opportunity to once again lead these efforts.

We have all heard stories of the stoic friend or relative who decides to quit, tosses their pack in the trash, and never lights up again. But it is well known that quitting smoking generally takes multiple attempts due to the highly addictive qualities of nicotine. Fortunately, quit rates have improved significantly with the widespread availability of quitlines, the development of effective forms of nicotine replacement therapy and other medications, and the launch of the highly effective campaigns, such as CDC’s TIPS From Former Smokers.

Public health departments can make further progress helping smokers quit using the same policy and systems change approaches that have worked to reduce youth smoking. A doctor’s advice to quit smoking continues to be one of the most effective interventions and health departments routinely make smoke-free messaging and state quitline resources available to clinicians for this purpose. Including smoking status as a “vital sign” at every patient visit is a great prompt for clinicians to advise smokers to quit. It continues to surprise me that this practice is not widespread, but many state and local health departments are now working with insurers and healthcare systems to make this a standard of care.

Quit attempts are more effective when smokers are supported by others. Tobacco quitlines are now available in every state and can be marketed to smokers through a variety of methods. About one half of state quitlines have mechanisms to allow referrals through healthcare system electronic health records. This allows the quitline to initiate calls and other supportive outreach services, which substantially improves successful cessation attempts. Many states are also beginning to experiment with new communications modalities to support quit attempts beyond the use of conventional telephone quitlines. Text messaging, chat rooms, and other forms of social media will ultimately be tested and tailored to support new audiences, improve cost efficiencies, and increase successful quit attempts.

It is increasingly important that public health leaders promote the widespread availability of nicotine replacement therapy (NRT). The vaping industry has been promoting electronic cigarettes as an effective and empathetic way to help smokers quit. Proponents of this approach seem to overlook the fact that FDA-approved NRT is now available in many forms, without the risk of potential adulterants or confusing dosing levels found in e-liquids. In addition, other prescription medications can further augment the effectiveness of NRT. States can help make all of these products more available to smokers by working with their state Medicaid programs and private insurers to increase coverage, eliminate copays, and provide free NRT to quitline clients who couldn’t otherwise afford it.

Last week, as national partners convened with leaders at the CDC’s Office on Smoking and Health (OSH), Corinne Graffunder, director of OSH, proclaimed 2019 the year of smoking cessation. In addition, a new report on smoking cessation from the U.S. Surgeon General will be released shortly to highlight new evidence-based practices. FDA Commissioner Scott Gottlieb has taken aggressive steps to stop a generation of children from becoming addicted to tobacco. Through these actions, federal and state officials are clearly focused on targeting the health consequences of nicotine, making this year’s Great American Smokeout particularly important as we expand our tobacco control efforts to include more active and extensive interventions to help current smokers quit.

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